Phil Couser MBE (Director of Public Health and Intelligence) talks about how, in a new wave of public health reform, we can take advantage of the transformational opportunities in harnessing the potential of data and digital technology to tackle the most intractable of Scotland’s health challenges.
“We live in the digital age – data is changing our lives. Many people live their lives through the prism of social media, there are cars capable of driving themselves and increasingly we buy online rather than in shops. The question is whether we’re doing enough in Scotland in exploiting the potential in digital technology underpinned by data to tackle our most intractable population health challenges.
“Clive Humby, the man behind the 1994 invention of the Tesco Clubcard, is credited with the term ‘data is the new oil’. This analogy emphasises the transformative value of data as a commodity. The Clubcard enabled Tesco to understand their customer base in a way that supermarkets had never before. This enabled the transformation that led to them becoming the dominant supermarket in the UK.
“Within health and care in Scotland in 2018 we’re not remotely close to a comparable level of understanding of our patient population. At a time when many are challenging the continuing validity of an analogy based on an old world commodity that exists in limited supply, in health and care we treat data more akin to an even older commodity, namely gold. We see it as precious and we focus on guarding it, driven by organisational concerns about security and information governance.
“Not only does this limit how we can exploit data’s transformative potential, but it causes harm by limiting the availability of data for safe and effective service delivery. If we’re to make major improvements in health, we need to change the way we look at data.
“There is hope in the form of the recently published Digital Health and Care Strategy and the Public Health Reform Programme. The former will bring together data within health and care to enable the provision of digital services more akin to those that citizens expect in their everyday lives. The latter will deliver a shiny new Public Health Scotland in 2019, but more importantly it will take forward wider system reform to deliver on the vision for ‘a Scotland where everybody thrives’.
“Making better use of data and intelligence was a key recommendation of the 2015 Public Health Review and there are opportunities to be exploited through linking with delivery of the Digital Health and Care Strategy and digital innovation across the public sector.
“However, given the impact of digital on lives today, are we giving it sufficient focus in taking forward our vision for public health?
“In the 19th century health in the UK was transformed by the Victorian investment in sanitation that provided clean running water for the masses. This is identified as the first wave of transformation in the history of public health. With clear reference to the physical assets that enabled the transformation it was titled the ‘structural’ wave. It was followed by the ‘biomedical’, ‘clinical’ and ‘societal’ waves; there is now an active debate as to what the next wave of public health should be.
“A ‘culture for health’ is a key component of the vision for public health in Scotland and it has been suggested that the next wave could be labelled as ‘cultural’. There is clearly sense in this, but how do we deliver the required cultural change?
“It could be argued that in the 21st century we need to invest in digital infrastructure in a similar way to the Victorian investment in sanitation. Extending the analogy further, it can be argued that in public health today, data is the transformative equivalent of clean water in the 19th century. Mirroring the focus on the means of transformation in the ‘structural’ wave, could the next wave to be ‘digital’?
“Ironically the use of data to provide new insight into health issues goes back to Victorian times – most notably in the work of John Snow in fighting cholera in London and Florence Nightingale’s work in the Crimea. If both were alive today they would probably be using data science to provide insight into the health challenges of our time.
“These pioneers were equipped with two of the three elements of data science: domain knowledge and an understanding of statistics. They didn’t have the technology that we have in our digital age that has exponentially increased our ability to collect and analyse data. Skills to make use of this technology (like programming) is the third element. Data science is critical to tapping into the potential of digital technology, without it we have a gushing pipe with more data than we can consume.
“By explicitly calling out a focus on digital and data science in our approach we stand a better chance of exploiting the transformational potential of technology and data together to deliver new approaches to old problems, in order to positively impact our most intractable health problems.
“Our next ‘Gathering’ event in September aims to move analysis into action. It seeks to optimise the impact of intelligence to improve the health outcomes of people across Scotland, now and in the future."
Meet Phil Couser
Phil Couser is Director of Public Health and Intelligence (PHI) at National Services Scotland.
Phil was recruited to his current post in May 2013. PHI brings together two well known public health focused and data rich former divisions of NSS, namely our Information Services Division and Health Protection Scotland.
After a career in the Army, Phil joined the NHS through NHS England’s Gateway to Leadership Programme. This led to an appointment as Associate Director for Planning, Performance and Practice Based Commissioning for NHS North of Tyne. In 2011 Phil moved to London to manage a Clinical Directorate in Guys and St Thomas’ Foundation Trust, from where he was recruited to his current post.